Primary Care Quality—Reply

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In reply

Drs Weissberg and Mustille raise an important point about the use of teams in primary care. Their description of a team approach to primary care reminds us that teams offer the promise of enhancing both access to care and quality. I agree entirely with this perspective and in fact have written elsewhere that the future of primary care depends on our use of teams.1 However, available data suggest that, at present, patients' predominant experience with primary care teams falls far short of this ideal. Consider that there is a distinction between "visible" and "invisible" team care. Visible team care refers to a model wherein clinicians from multiple disciplines each establish an ongoing relationship with the patient, with each fulfilling a role that is recognized and understood by the patient. Contrast this with invisible team care, in which the patient's experience of the other clinicians involved in their care is a more chaotic and incoherent one—a cast of characters whom the patient relates to as "not my doctor." Unfortunately, results from surveys of adults throughout the United States suggest that the latter continues to be patients' predominant experience—even in organizations that rely substantially on a team approach to primary care.1,2 There is no question that a team approach to primary care has enormous potential to improve health and health care quality. However, to this point, we are falling far short of the ideal for well-integrated visible team care that is required to capitalize on this potential.

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